ATI PHARMACOLOGY NSG 1540 EXAM 3
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Free ATI PHARMACOLOGY NSG 1540 EXAM 3 Questions
A nurse is providing education to a client with gout and a new prescription for allopurinol. Which of the following statements by the client indicates an understanding of the teaching?
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"I should take this medicine on an empty stomach."
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"If I get a rash from this medication, I will take my usual antihistamine."
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"I need to increase my fluid intake while taking this medication."
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"If I get a fever while taking this medication, I will take some aspirin."
Explanation
Correct Answer: C) "I need to increase my fluid intake while taking this medication."
Allopurinol works by inhibiting xanthine oxidase, reducing uric acid production in the body. Adequate fluid intake — typically 2 to 3 liters daily — is essential to promote renal excretion of uric acid and its metabolites, preventing the formation of uric acid kidney stones, which are a significant complication of gout. This statement reflects correct understanding of a key self-care instruction for allopurinol therapy.
Allopurinol should be taken with food or milk to reduce gastrointestinal irritation, not on an empty stomach. A rash while taking allopurinol can be a sign of Stevens-Johnson syndrome — a potentially life-threatening hypersensitivity reaction — and must be reported to the provider immediately rather than self-treated with antihistamines. Aspirin is contraindicated in gout patients as it can elevate uric acid levels by interfering with renal uric acid excretion, worsening the condition.
A nurse is evaluating the plan of care for a client who has AIDS and is receiving antiretroviral therapy (ART). Which client statement indicates the need for further teaching?
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I understand that missing doses can lead to resistance.
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I can stop taking my medications once my viral load is undetectable.
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I take my medications at the same time every day.
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I know this treatment will help me live longer.
Explanation
Correct Answer: B) I can stop taking my medications once my viral load is undetectable.
This statement indicates a dangerous misconception. ART must be taken continuously and indefinitely, even when the viral load becomes undetectable. Stopping ART allows the virus to rebound, can lead to drug resistance, and risks disease progression and transmission. An undetectable viral load is the goal of therapy — not a reason to discontinue it. The remaining statements reflect accurate understanding of ART therapy and do not require further teaching.
A nurse is preparing to administer IV ketorolac to a client who has postoperative pain. Which action should the nurse take before administering the medication?
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Mix the medication with a narcotic IV pain medication for synergistic effect.
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Confirm the client's renal function is within normal limits.
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Administer the medication quickly to provide immediate pain relief.
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Administer the medication before checking the client's vital signs to address the client's pain promptly.
Explanation
Correct Answer: B) Confirm the client's renal function is within normal limits.
Ketorolac is an NSAID that can cause nephrotoxicity, particularly with repeated dosing. Confirming normal renal function before administration is essential to ensure client safety. Ketorolac should never be mixed with opioids in the same syringe as precipitation may occur. It should be administered slowly, not quickly, to reduce adverse effects. Vital signs must always be assessed before medication administration — skipping this step is unsafe practice.
A client receiving azathioprine (Imuran) asks why frequent blood tests are required. What is the nurse's best response?
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"The tests evaluate whether the drug is causing bradycardia."
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"This medication can cause severe dehydration."
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"The tests help monitor for kidney stones."
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"We are checking for bone marrow suppression."
Explanation
Correct Answer: D) "We are checking for bone marrow suppression."
Azathioprine is an immunosuppressant that works by inhibiting purine synthesis, thereby suppressing the proliferation of immune cells. A major and serious adverse effect is bone marrow suppression — leading to leukopenia, thrombocytopenia, and anemia — which significantly increases the patient's risk of life-threatening infections and bleeding. Regular complete blood count (CBC) monitoring is essential to detect early signs of myelosuppression so that the dose can be adjusted or the medication discontinued before severe complications develop.
Azathioprine does not cause bradycardia, severe dehydration, or kidney stones — these are not recognized adverse effects of this medication and therefore do not explain the need for routine blood monitoring.
A nurse is caring for a client who is receiving basiliximab (Simulect) as part of an immunosuppressive regimen following a kidney transplant. Which finding should the nurse recognize as a potential indication of cytokine release syndrome?
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Gradual weight gain over several weeks
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Increased appetite and insomnia
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Sudden onset of fever and chills
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Constipation and abdominal bloating
Explanation
Correct Answer: C) Sudden onset of fever and chills
Cytokine release syndrome (CRS) is an acute systemic inflammatory reaction that can occur following administration of monoclonal antibodies such as basiliximab. It results from massive release of pro-inflammatory cytokines into the bloodstream, triggering a rapid systemic response. The hallmark presentation includes sudden onset of fever and chills, often accompanied by hypotension, tachycardia, dyspnea, and rigors. This is a medical emergency requiring immediate intervention including stopping the infusion and providing supportive care.
Gradual weight gain over weeks is more consistent with fluid retention or corticosteroid side effects, not CRS. Increased appetite and insomnia are common corticosteroid side effects unrelated to cytokine release. Constipation and abdominal bloating are gastrointestinal symptoms with no direct association with cytokine release syndrome.
A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?
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"Increase your intake of grapefruit juice."
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"Expect to have increased bruising."
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"Take this medication with food if nausea develops."
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"Monitor for muscle pain."
Explanation
Correct Answer: D) "Monitor for muscle pain."
Colchicine can cause myopathy and rhabdomyolysis, making it essential for clients to monitor and report muscle pain, weakness, or tenderness promptly. Grapefruit juice inhibits the metabolism of colchicine, increasing the risk of toxicity and should be avoided. Increased bruising is not a common or expected side effect of colchicine. While GI upset is common, the standard recommendation is to take colchicine with water and not specifically with food as a primary instruction.
A nurse is teaching a client about the signs of salicylate toxicity while taking aspirin therapy. Which client statement indicates an understanding of the teaching?
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"If I start hearing ringing in my ears, I should notify my provider."
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"I should ignore any side effects as long as the medication helps my pain."
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"I should expect my breathing to slow down slightly while on aspirin."
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"Aspirin toxicity usually causes constipation, so I'll increase my fiber intake."
Explanation
Correct Answer: A) "If I start hearing ringing in my ears, I should notify my provider."
Tinnitus — ringing in the ears — is one of the earliest and most classic signs of salicylate toxicity, occurring when aspirin blood levels become excessive. Recognizing this symptom and promptly reporting it to the provider allows for timely intervention before toxicity progresses to more serious manifestations such as hyperventilation, metabolic acidosis, altered mental status, and cardiovascular collapse. This statement demonstrates correct understanding of the teaching.
Ignoring side effects is dangerous and directly contradicts safe medication practice. Aspirin toxicity causes increased respiratory rate (hyperventilation), not slowed breathing, as the body attempts to compensate for metabolic acidosis. Salicylate toxicity is associated with nausea, vomiting, and diarrhea — not constipation — making increased fiber intake an inappropriate and misleading response.
A nurse is reinforcing teaching to a client who is beginning methotrexate therapy for rheumatoid arthritis. Which explanation should the nurse provide about the medication's mechanism of action?
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Methotrexate increases cartilage regeneration
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Methotrexate blocks pain receptors
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Methotrexate suppresses the immune response
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Methotrexate stimulates red blood cell production
Explanation
Correct Answer: C) Methotrexate suppresses the immune response
Methotrexate is a disease-modifying antirheumatic drug (DMARD) that works primarily by inhibiting dihydrofolate reductase, an enzyme essential for DNA synthesis and cell proliferation. In rheumatoid arthritis, this action suppresses the overactive immune response responsible for joint inflammation and destruction by reducing the proliferation of immune cells — particularly lymphocytes — that drive the autoimmune attack on synovial tissue. This immunosuppressive effect slows disease progression and reduces inflammation over time.
Methotrexate does not regenerate cartilage, block pain receptors, or stimulate red blood cell production. In fact, it can suppress bone marrow activity and reduce red blood cell production as an adverse effect, making option D not only incorrect but the opposite of its actual impact on erythropoiesis.
A nurse is caring for a client who has a bloodstream infection caused by a multidrug-resistant organism (MDRO). The nurse is preparing to administer intravenous vancomycin. Which action should the nurse take to reduce the risk of nephrotoxicity?
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Stopping the medication if the client reports nausea or vomiting
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Flushing the intravenous line with 0.9% sodium chloride before and after administration
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Monitoring the client's serum creatinine and blood urea nitrogen (BUN) levels before each dose
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Administering the medication over 15 minutes to reduce infusion-related reactions
Explanation
Correct Answer: C) Monitoring the client's serum creatinine and blood urea nitrogen (BUN) levels before each dose
Vancomycin is a glycopeptide antibiotic with well-documented nephrotoxic potential, particularly when serum levels are excessive or when used alongside other nephrotoxic agents. Monitoring serum creatinine and BUN before each dose allows the nurse to detect early signs of renal impairment — rising levels indicate the kidneys are struggling to clear the drug, necessitating dose adjustment or temporary discontinuation to prevent irreversible kidney damage. Therapeutic drug monitoring of vancomycin trough or AUC levels is also essential in clinical practice.
Nausea and vomiting are not indications to stop vancomycin — they are manageable GI side effects. Flushing the IV line is standard practice for line patency but does not reduce nephrotoxicity. Vancomycin must be infused slowly over at least 60 minutes — not 15 minutes — as rapid infusion causes Red Man Syndrome, a histamine-mediated infusion reaction characterized by flushing, erythema, and hypotension.
A nurse is teaching a client who is prescribed a broad-spectrum antibiotic. Which explanation should the nurse provide to describe the purpose of this type of medication?
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The medication treats a wide range of bacterial infections while waiting for culture results.
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The medication stimulates the immune system to produce antibodies against bacteria.
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The medication reduces inflammation by blocking histamine release from mast cells.
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The medication prevents viral replication during the early stages of infection.
Explanation
Correct Answer: A) The medication treats a wide range of bacterial infections while waiting for culture results.
Broad-spectrum antibiotics are designed to target a wide variety of both gram-positive and gram-negative bacteria and are commonly used empirically while awaiting culture and sensitivity results to identify the specific causative organism. They do not stimulate antibody production — that is the role of vaccines. They do not block histamine release — that is the mechanism of antihistamines. Antibiotics have no effect on viral replication, as they are ineffective against viruses.
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